Pharmacy benefit managers (PBMs) offer prescription drug benefit plans that allow members to have drug prescriptions filled at various in-network pharmacy locations. These locations may include retail locations, mail locations, or both retail and mail locations.
When a physician writes a prescription for a patient, the patient takes the prescription to a pharmacy to have the prescription filled. The pharmacy submits the prescription to the PBM for adjudication, fills the prescription, and accepts a co-pay from the patient. Once the PBM adjudicates the matter, it reimburses the pharmacy a predetermined amount for the specific drug sold to the patient. The pharmacy then purchases additional doses of the drug prescribed to the patient from a drug wholesaler in order to refill its stock.